{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T19:52:33Z","timestamp":1792785153725,"version":"4.5.0"},"reference-count":90,"publisher":"Georg Thieme Verlag KG","issue":"11","funder":[{"name":"Australian Research\nCouncil","award":["FT210100278"],"award-info":[{"award-number":["FT210100278"]}]},{"name":"National Health and Medical Research\nCouncil","award":["2008956"],"award-info":[{"award-number":["2008956"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Int J Sports Med"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Sport has traditionally been organised into male and female categories, but the\nincreasing visibility of transgender athletes has prompted sporting\norganisations worldwide to develop relevant eligibility regulations. These\npolicies range from hormone thresholds and open categories to puberty-based\nexclusions and blanket bans, yet they are rarely based on direct scientific\nevidence. This review aims to examine the historical evolution of transgender\ninclusion in sport, map current international regulations and evaluate the\nevidence underpinning these approaches. First, we outline the temporal evolution\nof eligibility frameworks. We then review the roles of sex hormones in\nperformance-relevant systems and assess how these mechanisms may result in\nphysiological changes in transgender athletes receiving testosterone- or\nestradiol-based gender affirming hormone therapy. Studies demonstrate that\ngender affirming hormone therapy induces physiological changes that may\ntranslate to measures of physical fitness, but are limited by cross-sectional\ndesigns, small cohorts, short follow-up periods, heterogeneous treatment\nregimens and outcome measures that are rarely sport specific. Therefore, the\ncertainty of this evidence remains low, and existing data are insufficient to\nsupport uniform policies across all disciplines. We therefore recommend that\nfairness and safety considerations should not be resolved through biology alone\nand propose a structured, sport-specific framework for policy development and\nrevision under uncertainty.<\/jats:p>","DOI":"10.1055\/a-2893-8339","type":"journal-article","created":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T23:15:53Z","timestamp":1781219753000},"page":"797-812","source":"Crossref","is-referenced-by-count":0,"title":["Trans-Inclusion in Sports: History, Scientific Evidence and Future\nDirections"],"prefix":"10.1055","volume":"47","author":[{"given":"Ananya M.","family":"Krishna","sequence":"additional","affiliation":[{"name":"Deakin University Faculty of Health, Victoria, Australia","place":["Geelong"],"department":["Institute for Physical Activity and Nutrition, School of Exercise and\nNutrition Sciences"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6860-587X","authenticated-orcid":false,"given":"Carlie","family":"Bauer","sequence":"additional","affiliation":[{"name":"Victoria University, Victoria, Australia","place":["Footscray"],"department":["Institute for Health and Sport"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimberley L.","family":"Way","sequence":"additional","affiliation":[{"name":"Deakin University Faculty of Health, Victoria, Australia","place":["Geelong"],"department":["Institute for Physical Activity and Nutrition, School of Exercise and\nNutrition Sciences"]},{"name":"University of Ottawa Heart Institute, Canada","place":["Ottawa"],"department":["Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac\nPrevention and Rehabilitation"]},{"name":"Baker Heart and Diabetes Institute, Victoria, Australia","place":["Melbourne"],"department":["Baker-Deakin Department of Lifestyle and Diabetes"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernadette","family":"Jones-Freeman","sequence":"additional","affiliation":[{"name":"Monash University, Victoria, Australia","place":["Melbourne"],"department":["Australian Regenerative Medicine Institute (ARMI), Faculty of Medicine,\nNursing and Health Sciences"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5257-5525","authenticated-orcid":false,"given":"Ada S.","family":"Cheung","sequence":"additional","affiliation":[{"name":"The University of Melbourne, Victoria, Australia","place":["Parkville"],"department":["Trans Health Research Group, Department of Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3271-6551","authenticated-orcid":false,"given":"S\u00e9verine","family":"Lamon","sequence":"additional","affiliation":[{"name":"Deakin University Faculty of Health, Victoria, Australia","place":["Geelong"],"department":["Institute for Physical Activity and Nutrition, School of Exercise and\nNutrition Sciences"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,7,13]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"2328","DOI":"10.1249\/MSS.0000000000003300","article-title":"The biological basis of sex differences in athletic performance: Consensus\nstatement for the american college of sports medicine","volume":"55","author":"S K Hunter","year":"2023","journal-title":"Med Sci Sports Exerc"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1111\/cen.13350","article-title":"Sex differences in athletic performance emerge coinciding with the onset of male\npuberty","volume":"87","author":"D J Handelsman","year":"2017","journal-title":"Clin 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